Management of Naja kaouthia Envenomation at a Quaternary Urban Medical Center: A Case Report

Snake envenomation is exceedingly rare in the United States. Nonetheless, herein we describe the case of a 26-year-old male who presented to our urban emergency department (ED) with monocled cobra (Naja kaouthia) bites to his bilateral upper extremities, subsequent monitoring for the development of compartment syndrome, and eventual treatment of a subacute wound infection.

The patient presented almost immediately after sustaining bites to his bilateral hands while descaling his pet cobra. Approximately 4 h later, he developed signs of neurotoxicity, which improved following the administration of antivenom. Orthopedic surgery was consulted to evaluate for possible compartment syndrome of the right upper extremity, but fortunately, he did not develop concerning symptoms on serial examinations. Six days later, the patient returned to the ED with purulent drainage from the right volar palm wound. The patient was admitted and started on intravenous antibiotics. However, due to persistent purulent drainage, he underwent two operative procedures for drainage of a palmar abscess. The patient's post-operative course was uncomplicated, and he recovered baseline function of his right hand.

Snake envenomation of the upper extremity can result in significant soft-tissue sequelae. Orthopedic practitioners must be aware of these complications and should also recognize signs and symptoms of acute intoxication when managing these patients.